CHA2DS2-VASc评分对慢性肾脏疾病患者冠状动脉支架内再狭窄的预测价值  

The predictive value of CHA2DS2-VASc score for coronary in-stent restenosis in patients with chronic kidney disease

作　　者：宋艳梅 车京津[1] 陈康寅[1] 徐延敏[1] 李广平[1] 刘彤[1] 张晓伟[1] SONG Yanmei;CHE Jingjin;CHEN Kangyin;XU Yanmin;LI Guangping;LIU Tong;ZHANG Xiaowei(Department of Cardiology,The Second Hospital,Tianjin Medical University,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Tianjin Institute of Cardiology,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院心脏科,天津市心血管离子与分子机能重点实验室,天津心脏病学研究所,天津300211

出　　处：《天津医科大学学报》2024年第1期65-69,共5页Journal of Tianjin Medical University

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-029A)。

摘　　要：目的:探讨CHA2DS2-VASc评分对慢性肾脏疾病(CKD)患者冠状动脉支架内再狭窄(ISR)的预测价值。方法:分析2019年1月—2022年1月行冠状动脉支架置入的CKD患者147例,平均年龄(66.6±10.9)岁,67.3%为男性。CKD的定义为根据MDRD公式得出的估算肾小球滤过率(eGFR)<60 mL/(min·1.73 m^(2))。根据是否发生冠状动脉ISR将患者分为ISR组(53例)和非ISR组(94例)。冠状动脉ISR定义为支架面积与正常直径相比狭窄>50%。收集患者基线临床资料、实验指标,计算术前CHA2DS2-VASc评分。采用多因素Logistic回归分析评估CHA2DS2-VASc评分对CKD患者发生冠状动脉ISR的影响。绘制受试者工作特征(ROC)曲线,评估CHA2DS2-VASc评分对CKD患者冠状动脉ISR的预测价值。结果:与非ISR组相比,ISR组糖尿病比例、单核细胞绝对值、CHA2DS2-VASc评分更高,eGFR、左室射血分数水平更低(χ^(2)=4.714,t=-3.605,Z=-2.997、-4.938,均P<0.05)。多因素Logistic回归分析结果显示,ISR组单核绝对值(OR=24.106,95%CI:2.500~232.395,P=0.006)、eGFR(OR=0.906,95%CI:0.858~0.956,P<0.001)和CHA2DS2-VASc评分(OR=1.377,95%CI:0.999~1.899,P=0.020)是CKD患者发生冠状动脉ISR的独立危险因素。ROC曲线显示,CHA2DS2-VASc评分预测CKD患者发生冠状动脉ISR的曲线下面积(AUC)为0.646,95%CI为0.557~0.735,敏感性为83.0%,特异性为55.3%。结论:CHA2DS2-VASc评分对CKD患者发生冠状动脉ISR的预测有临床应用价值。Objective:To investigate the predictive value of CHA2DS2-VASc score for coronary in-stent restenosis(ISR)in patients with chronic kidney disease(CKD).Methods:From January 2019 to January 2022,147 patients with CKD who had undergone successful stent implantation were included,with mean age of(66.6±10.9)years,67.3%being men.CKD was defined as the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73 m^(2))based on the formula of modification of diet in renal disease(MDRD).According to whether coronary ISR occurred,patients were divided into ISR group(n=53)and non-ISR group(n=94).Coronary ISR was defined as narrowing>50%in a stent area compared to normal diameter.The baseline clinical data and experimental indexes were collected,and the preprocedural CHA2DS2-VASc scores were calculated.Multivariate Logistic regression analysis was used to evaluate the effect of CHA2DS2-VASc score on coronary ISR in patients with CKD.The predictive value of CHA2DS2-VASc score for coronary ISR in patients with CKD was evaluated by receiver operating characteristic(ROC)curve.Results:Compared with the non-ISR group,the ISR group had higher rates of diabetes,monocyte absolute value,CHA2DS2-VASc score,and lower levels of eGFR and left ventricular ejection fraction(χ^(2)=4.714,t=-3.605,Z=-2.997,-4.938,all P<0.05).Multivariable Logistic regression found that absolute mononuclear values(OR=24.106,95%CI:2.500-232.395,P=0.006),eGFR(OR=0.906,95%CI:0.858-0.956,P<0.001),and CHA2DS2-VASc score(OR=1.377,95%CI:0.999-1.899,P=0.020)were independent predictors of coronary ISR in patients with CKD.ROC curve showed that the area under the curve(AUC)of CHA2DS2-VASc score in predicting coronary ISR in patients with CKD was 0.646(95%CI:0.5577-0.735),with a sensitivity of 73.6%and a specificity of 52.1%.Conclusion:CHA2DS2-VASc score has clinical application in predicting the occurrence of coronary ISR in patients with CKD.

关 键 词：冠状动脉支架内再狭窄 CHA2DS2-VASc评分 慢性肾脏疾病 

分 类 号：R541.4[医药卫生—心血管疾病]